Provider Demographics
NPI:1770841462
Name:RAK, ANNETTE (CCC-SLP)
Entity Type:Individual
Prefix:
First Name:ANNETTE
Middle Name:
Last Name:RAK
Suffix:
Gender:F
Credentials:CCC-SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4022 E GREENWAY RD
Mailing Address - Street 2:SUITE 11-122
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-4797
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4022 E GREENWAY RD
Practice Address - Street 2:SUITE 11-122
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-4797
Practice Address - Country:US
Practice Address - Phone:123-456-7890
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-01
Last Update Date:2015-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist